Written on April 30, 2012 – 9:22 pm | by normofthenorth
I saw a nifty podiatrist/chiropodist today, here in Toronto. (The two names are interchangeable here, though apparently not elsewhere.) My immediate problem was a nasty corn on top of a “hammertoe” that got very upset on my first ski week in Whistler, back in Jan-Feb. The bad toe was on my RIGHT foot, the one I’ve been calling my “good” one, though I did an ATR on that side in late 2001, and had it repaired surgically.
He examined my feet and legs and analyzed my gait very carefully, and told me I had CLAWtoes, not hammertoes. On both feet, too, though the causes were different. On the left, I’m compensating for a deficit in strength and stability, left over from my ATR. But it was my right ankle that worried him the most!
He says that I’ve been over-compensating for a deficit in dorsiflexion ROM, left over from my ATR surgery. When I mentioned it to my surgeon ~10 years ago, he said he did it on purpose, because “healing long” creates a functional deficit and healing short doesn’t. And I’ve basically agreed with him ever since. But no!!
This Doc said that my basic DF ROM was less than 15 degrees, which is the standard minimum a person needs to stride normally. (I.e., when you walk over your planted foot, that foot has to flex to 15 degs of DF to stay on the floor while your weight shifts to the other foot.) I don’t have that on my right (10 year post-op) ankle, so there are a few ways to “make do”:
(1) I could splay my toes out to the side. (I may do that when crouching on the volleyball court, but I don’t do that when walking.)
(2) I could hyper-extend my knee(s). (I did that as a kid, but he doesn’t think I’m doing it now while walking.)
(3) I could lift my heel earlier in my stride than “normal”. (I DO do that.) And
(4) I could open or dislocate the joint on the top of my foot, medial side, in front of my leg, which collapses my arch and gains me some DF ROM. (I DO do that, too.)
That joint involves the “halus” (bone? joint?), apparently. And he says that continuing to open or dislocate that joint while it’s got my FW (180-ish pounds) on it will eventually destroy the joint, and it will collapse.
He prescribed a few solutions:
(1) I can try some stretching, being careful to keep that joint closed while I’m doing it. One way is to push my thumb into the joint (where he did), but that’s hard while doing a WB stretch. The other is just to make sure that my knee and center-of-gravity are “inside”, almost in line with my big toe, when I stretch. He admitted that it was a long shot that stretching would gain me much AT-and-calf length 10 years after the surgery, but he thought it was worth trying for a few weeks.
(2) He customized two of my standard footbeds (new-issue from a pair of shoes — Skecher Shape-Ups — that I’d worn there), adding (a) a 1cm heel lift to decrease the DF I need to stride properly, and (b) a ~0.5cm meditarsal support (which he custom-made out of peel-and-stick fiber stuff) that holds up the balls of my feet under the base of all my toes except my big toes. That will let me load up the front of my foot WITHOUT doing the “claw toe” thing. (In my case, when I do “claw toe”, the big joints on my toe flex, knuckle up, banging on the top of my shoe or ski boot, and the smallest (philange?) joints hyper-extends. So each toe does a sideways “Z” when they’re pushing hard, but the meditarsal support discourages that.
He wants me to wear that customized footbed (and try the stretches) for 6 weeks then see him again to see if anything has changed.
Meanwhile, my right knee has been bothering me — mostly when I walk stairs, esp. down — and the sports-med Doc who’s been examining that has suggested that I consider custom footbeds in case the kneecap (patella) is out of place, so maybe this will help. (It already feels better than it did, but it does come and go; we’ll see.)
I was very surprised how concerned this foot-and-ankle-and-gait expert was about my “good” post-op leg — the one that CAN do a bunch of full-height 1-leg heel raises! — and how OK he was with my “bad” non-op leg — the one that has a clear strength deficit, though one that doesn’t seem to affect my running or jumping or bicycling or volleyball playing. And it made me re-think some of my oft-expressed (here) bias against early dorsiflexion stretching. I’ve been quite content with my reduced DF ROM on my post-op side. But I didn’t realize how reduced it was (because dislocating that foot joint fooled me, but not this Doc), and I certainly didn’t realize that doing what I’m doing is threatening the longer-term viability of that foot! (I’d been wondering if getting older and weaker would make me start limping on my other, post-non-op foot when I didn’t have enough calf strength to stride properly, but he made it sound like I’d lose the use of my other, post-op foot, sooner.
There’s today’s lesson from me, FWIW. Maybe the best audience for the message is Orthopedic Surgeons like my first one, who are tempted to trim ruptured ATs short, because it doesn’t do any harm. . . (Too bad they don’t read AchillesBlog.com!!)